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Press Release

Adult Health Problems Linked to Traumatic Childhood Experiences

Many of the most common causes of death and
disability in this country may be linked to adverse emotional
experiences in childhood, according to a study published today in
the American Journal of Preventive
Medicine.

The Adverse Childhood Experiences (ACE)
study, conducted by the Kaiser Permanente Medical Care Program in
San Diego, the Centers for Disease Control and Prevention (CDC),
Emory University in Atlanta, and the University of Arizona Health
Sciences Center in Tucson, suggests that childhood abuse and
household dysfunction lead to the development decades later of the
chronic diseases that are the most common causes of death and
disability in this country, including heart disease, cancer, chronic
lung and liver disease, and injuries.

Categories of abuse and household
dysfunction during childhood include psychological, physical, or
sexual abuse; violence against the mother; or living with household
members who were substance abusers, mentally ill or suicidal, or
ever imprisoned.

"Abused children may use behaviors such
as cigarette smoking, heavy alcohol use, overeating, promiscuity,
and drug use as a way of coping with damaging experiences much
earlier in life, "says a principal investigator of the study,
Dr. Vincent Felitti, Chief of Preventive Medicine at Kaiser
Permanente in San Diego.

Traditionally viewed as public health
problems, these behaviors appear to be coping mechanisms for people
who have had adverse childhood experiences, the study found. The
authors suggest the behaviors may also reflect the effects of the
adverse experiences on the developing brain chemistry -- effects
that may lead to the adoption of the coping behaviors.

The ACE study was designed to assess the
relationship between the childhood experiences and the current
health status and health risk behaviors of 30,000 mainly
middle-class adult members of Kaiser Permanente. To date, data have
been collected from 19,000 cooperating adults. Additional results
will be reported as more data are collected.

A strong relationship was seen between the
number of adverse experiences and self-reports of cigarette smoking,
obesity, physical inactivity, alcoholism, drug abuse, depression,
suicide attempts, sexual promiscuity, and sexually transmitted
diseases. Furthermore, persons who reported higher numbers of
adverse childhood experiences were much more likely to have multiple
health risk behaviors. Similarly, the more adverse childhood
experiences reported, the more likely the person was to have heart
disease, cancer, stroke, diabetes, skeletal fractures, liver
disease, and poor self-rated health as an adult.

Abuse and other adverse childhood
experiences, which the study suggests lead to adoption of health
risk behaviors as coping devices, may be two of the basic causes
that underlie health risks, illness, and death and could be
identified by routine screening of all patients, says Dr. Robert
Anda of CDC's National Center for Chronic Disease Prevention and
Health Promotion and a lead researcher on the study.

Emory University principal investigator and
pediatrician, Dr. Dale Nordenberg, emphasized that pediatric
professionals must provide support as early as possible to safeguard
and promote lifelong psychosocial and physical health. "This
study will help pediatric health care professionals to appreciate
that victims of abuse may experience long-term health effects and
even years of life lost," he says.

Felitti suggests that adults who have had
negative childhood experiences would benefit if they could talk
about them with someone they trust.

People who have been abused as children are
uncomfortable talking about their experiences, but that is exactly
what they should start doing, says Felitti. If people share their
emotionally painful past with a spouse or sibling or someone they
trust, it can start the healing process."

Kaiser Permanente, CDC, and Emory University
plan to continue their collaboration and to translate Kaiser
Permanente's experience in family-based interventions into the
development of programs that could serve as models for communities
throughout the country.

The American Journal of Preventive Medicine is the official journal of the
American College of Preventive Medicine and the Association of
Teachers of Preventive Medicine. The journal is published by
Elsevier Science in New York. The ACE study will eventually be
available on the Internet via AJPM Online, which can be found at
http://www.elsevier.com/locate/ajpmonline. Basic information on the
journal is also available at http://www.elsevier.com/locate/amepre.